静脉注射不同剂量地塞米松对膝关节镜术后收肌管阻滞的影响  

Effect of intravenous injection of different doses of dexamethasone on adductor canal block after arthroscopic knee surgery

作　　者：周潇 赵雅梅[1] 王振红[1] 孙蓓 王宏宇[1] 史宏伟[1] ZHOU Xiao;ZHAO Ya-mei;WANG Zhen-hong;SUN Bei;WANG Hong-yu;SHI Hong-wei(Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科,南京210006

出　　处：《实用药物与临床》2022年第7期610-614,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的评价术前静脉注射不同剂量地塞米松对膝关节镜术后收肌管阻滞效果的影响。方法择期全麻下行膝关节镜手术患者84例,男47例,女37例,年龄30~65岁,BMI 20~30 kg/m^(2),ASA I或Ⅱ级。采用随机数字表法分为3组:对照组(C组)、地塞米松5 mg组(D5组)、地塞米松10 mg组(D10组)。术前使用0.375%罗哌卡因共20 ml对3组患者行收肌管阻滞(ACB),C组、D5组、D10组行ACB前分别静脉注射2 ml生理盐水、5 mg地塞米松、10 mg地塞米松,术后均行舒芬太尼静脉自控镇痛(PCIA)。记录术后6 h、12 h、24 h、48 h患者静息和被动运动状态下的VAS疼痛评分。记录术后48 h内舒芬太尼用量、首次补救镇痛时间、补救镇痛次数。结果与C组相比,D5组术后6 h被动运动状态的VAS评分、术后24 h静息状态的VAS评分、术后48 h内舒芬太尼用量、首次补救镇痛时间、补救镇痛次数明显降低(P<0.05);与C组相比,D10组术后4个不同时点静息与被动运动状态的VAS评分、术后48 h内舒芬太尼用量、首次补救镇痛时间、补救镇痛次数明显降低(P<0.05);与D5组相比,D10组术后24 h被动运动状态的VAS评分、术后48 h内舒芬太尼用量、首次补救镇痛时间、补救镇痛次数明显降低(P<0.05);与术前空腹血糖相比,三组患者术后第1天空腹血糖均明显升高(P<0.05),与C组相比,D5、D10组术后第1天空腹血糖明显升高(P<0.05);与D5组相比,D10组术后第1天空腹血糖明显升高(P<0.05)。结论与静脉注射地塞米松10 mg相比,术前单次静脉注射地塞米松5 mg联合罗哌卡因行ACB,血糖仅轻微升高,与单纯使用罗哌卡因相比,镇痛效果显著。Objective To evaluate the effect of preoperative intravenous injection of different doses of dexamethasone on adductor canal block after arthroscopic knee surgery.Methods A total of 84 patients,47 males and 37 females,aged 30~65 years,with BMI 20~30 kg/m^(2) and ASA physical status I or II,scheduled for elective arthroscopic knee surgery under general anesthesia were divided into three groups by using random number table method:control group(C group),dexamethasone 5 mg group(D5 group),and dexamethasone 10 mg group(D10 group).Before operation,20 ml of 0.375%ropivacaine was used to perform adductor canal block(ACB)in three groups of patients.Before ACB was performed,groups C were injected intravenously with 2 ml of normal saline,D5 were injected intravenously with 5 mg of dexamethasone,and D10 were injected intravenously with 10 mg of dexamethasone.The sufentanil patient-controlled intravenous analgesia(PCIA)was given after operation.The VAS pain scores were recorded at 6 h,12 h,24 h,and 48 h after the operation during resting and passive motion state.The dosage of sufentanil within 48 hours after operation,the time of first remedial analgesia,and the number of remedial analgesia were recorded.Results Compared with group C,the VAS score of passive motion state at 6 hours after operation,the VAS score of resting state at 24 hours after operation,the amount of sufentanil within 48 hours after operation,the time of first remedial analgesia,and the number of remedial analgesia were significantly reduced(P<0.05)in group D5.Compared with group C,the VAS score of the rest and passive motion state at 4 different time points after operation,the dosage of sufentanil within 48 hours after the operation,the time of the first salvage analgesia,and the number of salvage analgesia were significantly reduced(P<0.05)in group D10.Compared with the D5 group,the VAS score of the passive motion state at 24 h after the operation,the amount of sufentanil within the 48 h after the operation,the time for the first salvage analgesia,and the

关 键 词：地塞米松 术后镇痛 收肌管阻滞 膝关节镜 

分 类 号：R614[医药卫生—麻醉学]